A minute later, the scrub nurse, Jenny Soto, glanced over at me. The glance was almost certainly unintentional; you could probably say it was involuntary. It was my cue nonetheless. In an operating room, no one looks at me—no one looks at anyone in my profession—until they’re absolutely sure we’re going to be needed.

Soto looked over, and I knew. It was time.

I walked over to one of the storage tables in the room, the one I knew my instrument was in. The instrument was about eighteen inches long, thin, and curved, wrapped in packaging so that it would be sterile until the moment of use. We called it the applicator. Next to it, also wrapped in packaging, was a capsule containing compressed nitrogen, and a cartridge with what we simply called the payload. All of the terms we used were as neutral as humanly possible. I retrieved each of these, put them on top of the storage table, and began unwrapping them.

Behind me the operating room had become a frenzy as Chao and her team struggled to keep their patient alive. The patient clearly had other ideas on the matter. I could hear the rattling as the patient jerked and spasmed on the table—whether because of an interaction with the anesthesia or as a side effect of the stroke I couldn’t say. I turned, my instrument fully assembled, and watched their activity for a few more minutes. Then, when I thought it was time, I walked up to the operating table.

Chao saw me coming and wasn’t pleased. “Back off.”

“Call it, doctor.”

“Get out of my operating theater.”

“Your patient is beyond saving, Dr. Chao. You need to call it.”

“I said get out!”

“Doctor, until you call it, I can’t do my job.”

“I don’t need you to do your goddamned job.”

“Dr. Chao,” I said, as gently as possible. “This isn’t about you. And you’re killing your patient.”

Chao swore and backed off from the table. There was dead silence for a moment. Chao swore again and kicked a storage table. It rattled with her fury.

Then she turned back around and faced her team.

“I’m calling it,” she said, and looked at the clock on the wall. “Patient deemed unsalvageable at 15:13. 3:13 p.m.”

“Thank you, doctor,” I said. Then I turned to the anesthesiologist, Dr. Osirio. “Remove the tubes from his mouth and throat, please.” He did.

I nodded to Nurse Soto. “You assist me. Everyone else stand back.”

Soto stayed. Everyone else stepped away.

I returned my attention to Soto. “You’ve done this before?”

“Yes, of course.”

“Then this should be quick. Open the mouth, please.”

Soto reached over and gently opened the patient’s mouth, which was slack and mostly lifeless. “Do you want me to move the tongue out of the way?” she asked.